FLA. OFFICIALS PROPOSE TOUGH PENALTIES FOR MEDICAID FRAUD, PRESCRIPTION ABUSE

State officials, conceding that fraud and abuse plague Medicaid's system
for dispensing narcotics and other dangerous drugs to the poor, want new
powers to kick out doctors, pharmacists and patients who cheat the
tax-supported care program.

Tougher penalties are among a host of proposals state government officials
and legislators have offered in response to the South Florida Sun-Sentinel
series "Drugging the Poor."

The four-part series, published this week, found that less than three
percent of the state's medical professionals prescribed more than two-
thirds of the narcotics and other dangerous drugs dispensed to Medicaid
patients in the past three years. These drugs cost taxpayers more than $346
million, helped feed a booming black market and added to a torrent of fatal
overdoses.

Many of the doctors who handed out the most Medicaid prescriptions, state
records show, also are linked to multiple drug-related deaths, or have
histories of professional misconduct and even, in a few cases, criminal
arrests.

The series identified millions of dollars in suspect pharmacy billings for
drugs such as painkillers and sedatives, including claims paid using the
billing numbers of doctors who were dead or ineligible to write prescriptions.

Dr. Rhonda M. Medows, secretary of the Florida Agency for Health Care
Administration, said the agency "is committed to reviewing" the newspaper's
findings.

"If any deficiencies are detected for which program controls have not
already been implemented, the agency will implement or seek legislation to
provide additional controls," she wrote in a prepared statement.

Medows said the agency's own data show that as many as 15 percent of
pharmacy claims "do not correctly identify the prescribing physician," a
situation that leaves officials unable to verify the legitimacy of millions
of dollars in drug prescriptions.

The secretary said the agency would ask the Florida Legislature to enact
new sanctions against doctors and pharmacists who routinely submit drug
claims bearing "erroneous information."

Medows also wants new powers to "prevent questionable [medical] providers"
from treating Medicaid patients and authority to "take action" against
patients who abuse Medicaid.

Kicking patients off Medicaid could prove highly controversial because
federal laws entitle people who meet eligibility criteria to medical care.
Mary Kahn, a spokeswoman for the U.S. Centers for Medicare and Medicaid
Services in Washington, had no immediate comment on the proposal.

Florida Attorney General Charlie Crist said he found the newspaper's
findings "alarming" and vowed to crack down on medical professionals
engaged in fraud.

"We're eager to do everything possible to protect the citizens of this
state," he said.

Crist said he thinks many billing abuses could be curbed by legislation
requiring doctors to be approved by Medicaid before they can prescribe
drugs to the poor. Under current law, doctors who are booted out of the
program for serious misconduct, even criminal convictions, can still write
these prescriptions and Medicaid pays the tab for them.

Such a law would give investigators more authority to audit doctors'
records and monitor drug prescribing, according to Crist.

"Medicaid fraud is extensive, and there are fatal consequences to some of
that fraud," said James McDonough, who heads the governor's Office of Drug
Control. "That's a serious problem."

The drug czar said he would take steps to persuade the state's two dozen
medical examiners to do a better job of reporting doctors with multiple
patient deaths to the state Department of Health for possible disciplinary
action.

"They have to be active in raising concerns when they can tie a number of
overdoses to a particular doctor," McDonough said. "That should be
something that they flag."

While the state health care agency admits that tighter fiscal controls are
needed over the $10 billion-a-year program, Medows said Florida has "the
most comprehensive prescribed drug fraud and abuse program in the country."

Some legislators said those controls are not enough.

"It concerns me that Medicaid dollars are being used to fund drug abuse,"
said Rep. Gayle Harrell, R-Stuart. She is the House sponsor of a bill to
create a statewide database that would track all controlled drug
prescriptions, so that doctors would be able to determine whether their
patients are receiving medications from more than one medical office at a time.

Harrell said the prescription tracking plan, which is to be funded at least
partly by a $2 million payment from Purdue Pharma, manufacturer of the
painkiller OxyContin, will "make a tremendous difference.